TB Infection Control and Prevention

Patients are placed in airborne precautions when suspected of having tuberculosis (TB) because inhaling Mycobacterium tuberculosis particles allows them to reproduce and disperse via the lymphatic system. TB can be spread through coughing, sneezing, laughing, singing, and speaking, but not through sharing cups or utensils, nor by shaking hands, kissing, or using toilet seats or bed linens. Patients with TB must be isolated and treated with a lengthy medication regimen, typically lasting 6-9 months. Those with active TB infections are contagious, while latent TB infections are not. Diagnostic methods include the tuberculin skin test, TB blood test, and chest x-ray. Healthcare professionals must wear N95 masks and follow strict precautions to prevent transmission.

Running head: DEVELOPING AND CHANGING 1
Developing and Changing Poplarville, Mississippi
Earnest Job
School of Nursing

DEVELOPING AND CHANGING 2
Abstract
Poplarville, a small town located in Mississippi, is changing rapidly. Cultural diversity,
new economic development, and social and health management issues create increased anxiety
for the community leaders. Health care workers feel stressed as more patients require treatment
for diseases and health issues that are unfamiliar. Education for health care workers regarding
new cultures and disease management is needed. Community members need to be educated on
disease management, with continued access to medications at free or discounted prices.
A community health clinic, located in the old locally owned grocery store, would provide
a venue for nurse practitioners to provide comprehensive health care and education to all
community members. Diabetic, HIV/AIDS and TB medications could be provided free or at
reduced prices. Educational information on swimming, safe sex, diabetes, tuberculosis,
HIV/AIDS, depression and nutrition could be offered.
Nurse practitioners would be available to provide education to local nurses and medical
providers regarding cultural diversity, disease management and support for increasing health
related problems.

DEVELOPING AND CHANGING 3
Developing and Changing Poplarville, Mississippi
Poplarville is a town in crisis. The small rural community is growing rapidly with the
major construction of a new resort and casino. New cultures, with the addition of South African
workers, more Native Americans and Eastern Europeans, are bringing different medical and
social issues to the medical professionals. With an aging medical provider soon to retire, the
closing of the small grocery where many people were provided with free medications, and
frustrated hospital nurses regarding lack of knowledge regarding unknown diseases, a bold step
needed to be taken.
What if the money currently sitting untouched in the “Swim out of the Weeds” fund,
which has grown to $1.5 million, could be utilized to purchase the small grocery and convert it
into a community health clinic that would be run by nurse practitioners?
Ethically, this plan would be benefitting the community in many ways. It would provide
comprehensive health care and education to all community members which would follow the
principle of beneficence, to do what is good (Rainbow, 2002). It would also allow the
community members to make decisions that apply to their lives and have some control over their
life experiences.
Diabetic, HIV/AIDS and TB medications could be provided free or reduced prices. The
small grocery store was providing this to the community, and in view of the fact that the store is
closing, this would be a way to follow the ethical principle of doing least harm.
Educational information on safe swimming would keep the original plans for the money
intact, which would be fair and just for the community members that established the trust fund
many years ago. Education on safe sex, diabetes, tuberculosis, HIV/AIDS, depression and
nutrition would also be provided.

DEVELOPING AND CHANGING 4
Nurse practitioners would be available to provide education to local nurses and medical
providers regarding cultural diversity, disease management and support for increasing health
related problems.
Approaching the remaining benefactors of the trust fund, along with the community
planning committee, with the explanation utilizing the ethical principles as outlined, should
provide all involved with enough beneficial reasons to utilize this money for the establishment of
a community health clinic.
Diversity issues arise rapidly when people from other countries begin to arrive in a
community. Poplarville, with a small population of Native Americans, now has seen an increase
in this culture due to the casino being built. South African and Eastern Europeans have now
arrived, which this community knows nothing about. An aging population is now experiencing
more youth and young adults with small children. New diseases and unfamiliar customs and
beliefs are being experienced. Life as many of the community members knew it, is now
changing rapidly (Davis, 2014).
The community clinic will be able to help with some of these changes, by providing
education on cultural diversity issues, new and unfamiliar customs and health related problems.
Providing care for a diverse population, the medical professional will be able to identify the
uniqueness of each patient they encounter. It does not matter what the person looks like or if
they have an accent, if their beliefs are different from yours, what matters is they are a patient
seeking help.
Genetics and genomics have important roles in both the health and disease management
of individuals. Genomic variants are a contributing factor in nine of the ten leading causes of
death in the United States, which include diabetes and cardiovascular disease ("National Human

DEVELOPING AND CHANGING 5
Genome Research Institute," 2014). A person’s family health history will provide an
understanding for many of the causes of inherited diseases and conditions.
As the various ethnic cultures establish their presence in Poplarville, it is imperative to
determine a detailed family history, if at all possible, from each person as they are seen in the
clinic. The provider will be able to help the patient establish a healthy lifestyle, provide them
with appropriate education regarding any predisposition to a certain disease and offer guidance
related to any specific testing they might require.
Mississippi has many health concerns, such as obesity, diabetes, cancer, kidney disease,
arthritis, and cardiovascular disease. Working with a population that has deeply rooted health
concerns, causes the nurse’s role to become difficult. Nurses, collaborating with individuals
within the community, provide education and supervision to create the healthiest environment
possible.
Primary prevention is concerned with prevention of disease processes (Fitzgerald, 2011).
Examples of primary prevention are health education to students, vaccinations and restraints in
vehicles to prevent injury during a motor vehicle accident. The “Swim out of the Weeds” fund
was a primary prevention fund in Poplarville. The community formed this fund to prevent future
deaths from drowning. Unfortunately, the program was unsuccessful due to state mandated
educational requirements within the school system. By offering on going education regarding
safe swimming practices, this primary prevention will be able to continue.
Secondary prevention measures prevent further decline in one’s health, where
predisposing risk factors are already in place (Fitzgerald, 2011). With an influx of South African
laborers, more Native Americans and Eastern European workers and the diseases that they may
have, it is vital for the nurse to educate the residents of Poplarville. The contracted laborers need

DEVELOPING AND CHANGING 6
education on how to prevent the spread of disease and infection. The South African population
has a high rate of human immunodeficiency virus (HIV) and Tuberculosis (TB). Many have not
been treated for these diseases and are uneducated on the prevention of how the disease is
spread. Due to the high prevalence of HIV, the spread of TB has become rampant among the
South African population.
Among the Native American and local population, there is a high prevalence of diabetes
mellitus. Proper education about how to control this disease process could decrease the number
of people with diabetes risk factors. Secondary disease prevention would consist of education
regarding diet and exercise. Routine checkups for people predisposed to diabetes and those with
diabetes would greatly decrease their risk for premature death. Other prevention measures would
consist of diabetic friendly cooking classes and exercise classes geared toward different age
groups.
Of great concern in the community, is the alarming rate at which young women are
becoming pregnant. Along with this is the fear of spreading HIV, TB, and other sexually
transmitted infections when these young women are uneducated regarding how these diseases are
spread. Domestic violence and alcohol related accidents have become very concerning in
Poplarville. Education regarding the dangers associated with these issues could prevent further
violence and accidents.
Tertiary prevention is the care given to patients who have established diseases and health
issues. The goal in tertiary care is to; prevent further damage, increase the quality of life and
prevent premature death (Fitzgerald, 2011). The local population has an established issue with
diabetes. Creating a community health clinic where patients could receive continuing care along
with free or reduce priced medications, will help maintain their current health status.

DEVELOPING AND CHANGING 7
Advanced practice nurses can apply his or her assessment skills to the populations of
patients with unfamiliar disease processes. Obtaining a detailed health history and understanding
the patient’s current medical treatment is important in identifying possible risk factors for other
diseases as well.
If a patient has had a known history of tuberculosis (TB) in the past, it is vital to complete
a chest x-ray, HIV blood test and determine what medications, if any, the patient was treated
with. If the patient does not have a previous history of the disease, an assessment for cough,
fever, any recent fatigue or lethargy, should be evaluated and the patient should be asked if they
waken drenched in sweat. A 2-step tuberculosis screening should be obtained if the patient is
exhibiting any signs and symptoms (Thompson, 2013).
According to the Mississippi State Board of Health, in 2013 there were 64 cases of
tuberculosis, 16 of these cases were foreign born persons (United Health Foundations, 2014).
The CDC states that there were 9,582 reported cases of TB in the United States (CDC, 2014).
South Africa has the third highest prevalence of TB in the world. An estimated 80% of South
Africa’s population is infected with tuberculosis, and 66% of these people are infected with TB
and HIV (CDC, 2014).
Tuberculosis is an airborne respiratory illness in which can be spread by coughing and
speaking. Tuberculosis is rarely spread with brief exposure, but more commonly spread by
repeated exposure with an infected individual. 45% of tuberculosis cases in the United States
affect African patients. Tuberculosis is caused by an infection of mycobacterium tuberculosis in
the lungs. The small droplets containing mycobacterium tuberculosis remain airborne for hours
while indoors. Once inhaled the mycobacterium tuberculosis particles harbor in the bronchioles

DEVELOPING AND CHANGING 8
and alveoli thus allowing them to reproduce and disperse via the lymphatic system (Lewis,
Dirksen, Heitkemper, Bucher, & Camera, 2011).
Assessing the patient for HIV can be difficult. The APN will have to ask the patient if
they have a known HIV infection, their number of sexual partners and any recent sexually
transmitted infections and are they needle drug users. Fevers are often seen in HIV patients,
even those who are otherwise asymptomatic. Patients with weakened immune systems are
unable to fight infections efficiently, and fevers may be common. Cytomegalovirus retinitis,
with symptoms such as, “floaters” in the line of vision, blurry vision or even blindness, is also
common in the patient with HIV. Oral yeast infections, or thrush, and enlarged lymph nodes
may also be seen in the HIV patient. Abnormal pain or nodules in the abdomen may indicate
enlarged liver or spleen. Wasting syndrome is seen in the HIV patient during the final stages of
HIV, so the patient’s weight should be monitored. A ten percent decrease in weight during a
thirty day period is often seen with wasting syndrome (New York State Department of Health,
2007).
An estimated 15.9% of the United States, both diagnosed and undiagnosed, is living with
HIV (CDC, 2014). Nearly 47% of Mississippi’s population is living with HIV (MSDH, 2010).
African Americans living in MS make up 78% of the HIV population, and non-Hispanic whites
making up 9.75% of the HIV population (MSDH, 2010). 17.9% of South Africa’s population is
living with HIV.
Poplarville has a high prevalence of diabetes, most likely secondary to obesity. Greater
than 34% of Mississippi residents are diabetic, according to the United Health Foundation annual
data report (UHF, 2014). The United States has a lesser overall population of diabetics, just over

DEVELOPING AND CHANGING 9
9%, and increasing slightly despite education and exceptional healthcare (American Diabetes
Association, 2014).
Native Americans in the United States have the highest prevalence of diabetes than any
other ethnicity in the country, at 15.9%, as compared to 7.6% of the non-Hispanic white
population and 13.2% of the non-Hispanic black population (ADA, 2014).
Diabetes mellitus is a disorder related to insufficient or absent insulin supply. Diabetes is
classified as Type 1 and Type 2 diabetes. Type 1 diabetes, formerly known as juvenile diabetes,
is an insulin dependent form of diabetes due to the body destroying its pancreatic beta cells
affecting its own source of insulin. These patients are required to receive insulin injections in
order to regulate blood glucose levels. Type 1 diabetes mellitus is diagnosed before the age of
20, whereas type 2 diabetes mellitus is more commonly diagnosed after the age of 35. Type 2
diabetes mellitus is the lack of sufficient insulin needed for bodily use. This can be related to
insufficient supply of endogenous insulin or the body’s poor utilization of the insulin produced.
Type 2 diabetes mellitus can be the cause of four major metabolic abnormalities including:
insulin resistance, fatigued pancreatic beta cells unable to produce insulin, excessive hepatic
glucose production, and alterations in hormones and cytokines production in adipose tissue. Not
all patients with type 2 diabetes mellitus require manufactured exogenous insulin. Type 2
diabetes mellitus can be treated by dietary therapy, exercise, and oral hypoglycemic methods
(Lewis, Dirksen, Heitkemper, Bucher, & Camera, 2011).
The nurse led clinic in Poplarville will provide patients with necessary treatments
including but not limited to dressing changes, medication administration, and education.
Diabetes affects the body’s ability to heal and prevent infections. It is important that those
diabetic patients have proper dressing changes to their wounds to prevent further infections and

DEVELOPING AND CHANGING 10
problems. The nurse led clinic will be responsible for administering and supplying medications
to the patients, along with providing necessary education to these patients on proper medication
instructions.
At the present time, there is a shortage on insulin for the diabetic patients. It is important
for the clinic to receive grants to increase supply of insulin for use in the community. When it
comes to tuberculosis treatment, it is extremely important that the nurse educators provide
education to these patients about the necessity for medication compliance and adherence to the
drug regime for treatment. Tuberculosis is treated with a variety of drugs including: isoniazid,
rifampin, pyrazinamide, ethambutol, rifabutin, and rifapentine (Lewis, Dirksen, Heitkemper,
Bucher, & Camera, 2011). The regime is formulated based upon the severity of the disease. The
treatment time for tuberculosis can take up to nine months. These drugs are very expensive and
it is important that once prescribed the patient is compliant with the long treatment time to
prevent reoccurrence or antibiotic resistance. The nurse educator must educate the patient on the
necessity of compliance with the regime for the entire duration.
Advanced practice nursing would be utilized in this community in a variety of ways. The
nurse led clinic will be staffed with advanced practice nurses from different specialties. The
nurse practitioners will be responsible for assessment and treatment implementation in the
patients. The nurse educators will be responsible for education and continuing education with
the patients based on their disease process. Nursing administrators will be responsible for the
grants necessary to build the clinic and, furthermore, managing staff during operation. Finally,
the community nurse will be responsible for assessment of the population and environment.
Our nurse led clinic will be based upon the theories of Florence Nightingale.
Nightingale’s theory is based upon a foundation of person, environment, health and nursing. The

DEVELOPING AND CHANGING 11
person, being the patient, is acted upon by the nurse, affected by the environment, and has their
own representative powers. The environment is the foundation of the theory. The environment
includes physical, psychological, and social factors. The concept of health is held by the
person’s wellbeing, maintained by environment, and increased with the nurse’s assistance. The
final concept of nursing is aimed at setting an environment to facilitate the patient’s wellbeing
and health improvement (Current Nursing, 2011). This theory pertains to our nurse led clinic in
the idea that the patient is the upmost priority. The patient’s care is based upon their
environment and the resources available. The patient can choose whether or not follow their
individual plan of care. The nurses are provided to encourage compliance and implement the
plan of care to regain a healthy status.
The integration of South African workers and additional Native Americans and Eastern
Europeans into the Poplarville community has not only increased health risks through
introduction of new disease processes, it has also increased the non-disease public issues.
Although drowning concerns already existed in the area, the community is now seeing an
increase in domestic violence, construction injuries, teenage pregnancies, alcohol abuse and
drowning.
In order for the community to decrease the prevalence of such issues, community leaders
must act quickly to improve processes and education of community members. Through the
community health fair, advanced practice nurses can begin to provide education on the
previously mentioned issues as well as inform the community of the establishment of the new
community health clinic. Offering services through the clinic on domestic violence support and
safety measures while working in dangerous work zones along with the medical services have
the potential to decrease the frequency of such non-disease issues.

DEVELOPING AND CHANGING 12
In view of the recent drowning of two children, the community nurse will work alongside
other community leaders to address the safety concern. Assessment of private property pools,
free standing lakes and ponds, and other bodies of water to ensure compliance with safety codes
will help decrease the potential for drowning. Community education at the community health
clinic on child and adult water safety will also be available.
Teenage pregnancy rates have also increased in the past twelve months. Labor and
delivery nurses are blaming the recent introduction of a more diverse population. The
community health clinic will provide education on teen pregnancy, safe sex, and dangers of
sexually transmitted diseases. The community clinic can also provide education for the young
mothers on raising a child, healthcare screenings and checkups for the infants and mothers, and
other necessary medical treatment.
Construction injuries are of great concern as the local hospital is seeing an increase in
patients presenting with construction injuries. Safety education on safe working environments
and assessment of alcohol levels of construction workers coming to the emergency room will
help improve the issue. The community leaders, emergency department nurse leaders, and
construction site leaders must meet to assess and develop a plan to decrease the number of
construction injures through appropriate assessment of causes.
A teaching plan for the hospital medical personnel has been developed as a mandatory
web-based review of tuberculosis (“Appendix A”). Hopefully, a better understanding of the
disease will be gained after completion of the review.
Overall, the community health clinic will play a fundamental role in improving
community members’ and community medical personnel’s knowledge and understanding of both
disease and non-disease issues and concerns. The advanced practice nurses, community health

DEVELOPING AND CHANGING 13
nurses, and ancillary healthcare staff must work together to initiate a plan for improvement as the
establishment of the casino and new residents will not be going away.

DEVELOPING AND CHANGING 14
References
American Diabetes Association, ADA (2014). Statistics about Diabetes. Retrieved from
http://www.diabetes.org/diabetes-basics/statistics/
CDC (2014). Statistics overview: HIV/AIDS. Centers for Disease Control and Prevention.
Retreived from http://www.cdc.gov/hiv/statistics/basics/
Current Nursing. (2011). Retrieved November 16, 2014, from Nursing Theories: a companion to
nursing theories and models:
http://currentnursing.com/nursing_theory/nursing_theorists.html
Davis, C. (2014). Celebrating diversity, one patient at a time. Nursing made Incredibly Easy.
http://dx.doi.org/10.1097/01.NME.0000454751.82121.39
Fitzgerald, M.A. (2011). Primary, secondary and tertiary prevention: Important in certification
and practice. Fitzgerald: Health Education Associates. Retrieved from
http://fhea.com/main/index.aspx?p=CertificationCols/level_prevention
Frequently asked questions about genetic and genomic science. (2014). Retrieved November 20,
2014, from www.genome.gov
Lewis, Dirksen, Heitkemper, Bucher, & Camera. (2011). Medical Surgical Nursing: Assessment
and Management of Clinical Problems (Vol. 1 & 2). St Louis, Missouri: Elsevier Mosby
Mississippi State Department of Health (2010). Mississippi HIV Statistics. Retrieved from
http://www.msdh.state.ms.us/msdhsite/index.cfm/14,0,150,134,html
New York State Department of Health (2007). Primary care approach to the HIV-infected
patient. Agency for Healthcare Research and Quality. Retrieved from
http://www.guideline.gov/content.aspx?id=34268

DEVELOPING AND CHANGING 15
Rainbow, C. (2002). Descriptions of ethical theories and principles. Retrieved from
http://www.bio.davidson.edu/people/kabernd/indep/carainbow/theories.htm
Thompson, E.G.(2013). Medical history and physical exam for tuberculosis. WebMD.
Retrieved from http://www.webmd.com/a-to-z-guides/medical-history-and-physical-
exam-for-tuberculosis-tb
United Health Foundation (2014). State data: Mississippi. America’s Health Rankings.
Retrieved from http://www.americashealthrankings.org/MS

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“Appendix A”
Teaching Plan
Web Based Mandatory Review on Tuberculosis
Objective: By the end of the mandatory review, staff members will be able to recognize signs
and symptoms of Tuberculosis and be able to adequately care for patients with Tuberculosis
according to hospital policy.
Instructions: Review the attached document. Once you have reviewed the document, complete
the attached quiz and submit. You must complete the quiz with a minimum of 90% accuracy.

DEVELOPING AND CHANGING 17
Review on Tuberculosis
Tuberculosis, also known as ‘TB’, is an airborne respiratory illness, which can be spread by
coughing, sneezing, laughing, singing and speaking. TB is rarely spread through brief exposure,
but more commonly spread by repeated exposure with an infected individual. Of the infected
individuals in the United States, 45% of the cases are Africans.
Tuberculosis is caused by an infection of mycobacterium tuberculosis found in the lungs. Small
droplets containing mycobacterium tuberculosis can remain in the air for hours, which is why
patients are placed in airborne precautions. Once the mycobacterium tuberculosis particles are
inhaled, they harbor in the bronchioles and alveoli allowing them to reproduce and disperse via
the lymphatic system.
Again, TB can be spread through coughing, sneezing, laughing, singing, and speaking.
Tuberculosis is not spread through sharing of cups, silverware, or saliva such as with kissing, nor
can it be spread through toilet seats, bed linens, or shaking someone’s hand. Signs and symptoms
of Tuberculosis include fatigue, weakness, fever, weight loss, and night sweats. If the infection is
in the lungs, infected individuals may also complain of chest pain and a cough that is typically
productive with blood-tinged sputum. Individuals suffering from HIV infection are at greater risk
for TB. Patients suffering from diabetes, previous TB exposure (dormant), TB infection within
the last two years, alcohol abuse are at a significantly greater risk for developing and becoming
sick with Tuberculosis.
Not everyone with the TB infection become sick. This is because TB can be latent and lay
dormant known as latent TB infection, which is not contagious, versus TB disease where the
individual’s body is actively fighting off the infection. There are a number of diagnostic methods
for TB. Tuberculin skin test, TB blood test and chest x-ray are of the most common diagnostic
methods for TB. Individuals infected with Tuberculosis must be compliant with the lengthy
medication regimen typically lasting between six to nine months.
Patients presenting with complaints of fatigue, weakness, fever, weight loss, or night sweats
should immediately be isolated and treated as airborne precautions. Tuberculosis patients, even if
only suspected, must be placed in a negative air pressure room. N95 masks are to be worn by all
hospital employees. Each employee is to wear the mask specifically fitted for him or her as of the
most recent fit testing. The room door must remain closed at all times.

DEVELOPING AND CHANGING 18
If the patient must leave the room, an N95 mask is to be applied to the patient prior to exiting the
room. Employees transporting the patient are not required to wear the mask if the patient has one
on. Visitors are to be limited and children are prohibited. All visitors must be educated on
wearing personal protective equipment. If a patient test results return as positive, follow-up of
family and friends that have come in contact with the patient is to be coordinated with the Health
Department.

DEVELOPING AND CHANGING 19
Tuberculosis Review Quiz
1. Which of the follow is not a method of transmission of Tuberculosis?
a. coughing
b. sneezing
c. hand shaking
d. singing
2. A patient presents with complaints of cough, fever, and night sweats. The patient is a new
resident of the area who relocated from South Africa for the new casino. What is the first thing
you should do?
a. place the patient in a negative air pressure room
b. apply an N95 mask on the patient
c. notify the physician
d. continue completing admission questions
3. If a patient has a known history of latent TB infection, they are considered contagious.
a. True
b. False
4. Once a patient is placed in a negative air pressure room, the door may remain open as the
negative airflow will make necessary adjustments to prevent transmission.
a. True
b. False
5. Small children are permitted in a patient’s room who presented with signs and symptoms of
Tuberculosis until it is confirmed whether or not the patient has TB.
a. True
b. False

DEVELOPING AND CHANGING 20
6. Which of the following is not a diagnostic method for Tuberculosis?
a. chest x ray
b. TB skin test
c. TB blood test
d. TB urine sample
7. If you do not know what N95 mask you were most recently fitted for you can continue to care
for the patient and just choose the mask that feels the best.
a. True
b. False
8. Which of the following can result in greater risk for patients to become infected with TB?
a. alcohol abuse
b. diabetes
c. HIV
d. all of the above
9. A patient who is positive for Tuberculosis is actively coughing up blood-tinged sputum. The
patient is currently in a negative air pressure room. Because the droplets fall to the ground so
quickly, it is ok for you to no longer wear your mask once medication regimen has been started.
a. True
b. False
10. Who should you contact if a patient refuses to comply with treatment and are a known active
TB case?
a. the physician
b. the health department
c. the police
d. the charge nurse